Healthcare Provider Details

I. General information

NPI: 1659831188
Provider Name (Legal Business Name): LORELIS L PLOCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD
HOLLYWOOD FL
33021-6917
US

IV. Provider business mailing address

450 N PARK RD
HOLLYWOOD FL
33021-6917
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax:
Mailing address:
  • Phone: 916-974-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25038
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number23-474
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: